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  • "In April 2019 the abortion telemedicine service Women on Web (WoW) opened their helpdesk to Germany and saw a progressive rise in consultations. Our aim was to understand the motivations, and perceived barriers to access, for women who choose telemedicine abortion outside the formal health sector in Germany. Methods: We conducted a parallel convergent mixed-methods study among 1090 women in Germany, who requested medical abortion through WoW between January 1st and December 31st, 2019. We performed a cross-sectional study of data contained in online consultations and a content analysis of 108 email texts. Analysis was done until saturation; results were merged, and triangulation was used to validate results. Results: Frequent reported reasons for choosing telemedicine abortion in the consultation forms were quote: I need to keep the abortion a secret from my partner or family (48\%), and quote: I would rather keep my abortion private (48\%). The content analysis developed two main themes and seven subsidiary categories: 1) internal motivations for seeking telemedicine abortion encompassing i) autonomy, ii) perception of external threat, iii) shame and stigma, and 2) external barriers to formal abortion care, encompassing : (iv) financial stress, v) logistic barriers to access vi) provider attitudes, and vii) vulnerability of foreigners). The findings in the quantitative and qualitative analysis were consistent. Conclusion: Women in Germany who choose telemedicine abortion outside the formal health sector do so both from a place of empowerment and a place of disempowerment. Numerous barriers to abortion access exist in the formal sector which are of special relevance to vulnerable groups such as adolescents and undocumented immigrants.Competing Interest StatementRebecca Gomperts is the founder and director of the telemedicine abortion service Women on Web, Hazal Atay and Sophie Gunther are affiliated to Women on Web.Funding StatementThe study was funded by the Swedish Society of Medicine SLS-783181Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesThe details of the IRB/oversight body that provided approval or exemption for the research described are given below:Ethics Committee Karolinska Institutet Dnr 2009/2072-31/2All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.YesAll data available upon reasonable request." Die Daten des kumulierten ALLBUS von 1980-2014 wurden als Ergänzungsdatensatz verwendet. (xsd:string)
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  • https://doi.org/10.1101/2020.09.08.20190249. (ALLBUS) (xsd:string)
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  • Aufgenommen: 35. Fassung, Dezember 2020 (xsd:gyear)
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  • 2020 (xsd:gyear)
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  • 10.1101/2020.09.08.20190249 ()
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  • Why women choose abortion through telemedicine outside the formal health sector in Germany? A mixed-methods study (xsd:string)
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  • 11.12.2020 (xsd:gyear)
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